Depressive symptoms in particular, but also chronic stress in life, increase the risk of older people having a stroke or transient ischemic attack, says researchers, who found feelings of hostility, but not anger, were also a risk factor for cerebrovascular disease.

The study of over 6,700 people aged between 45 and 84 years, reported in the American Heart Association’s journal Stroke, compared the rates of full and mini-stroke between people of different psychological profiles rated via questionnaire.

Compared with people who had healthy psychological scores, those with the poorest scores showed the following percentage increases in their likelihood of suffering a stroke or transient ischemic attack (TIA):

On the effect of feelings of hostility – “which is a negative way of viewing the world” and was assessed by the person’s “cynical expectations of other people’s motives” – this resulted in a doubling of the risk versus people who did not score highly on this profile. Feelings of anger, however, had no effect.

Dr. Susan Everson-Rose, lead author and associate professor of medicine at the University of Minnesota in Minneapolis, says:

“There’s such a focus on traditional risk factors – cholesterol levels, blood pressure, smoking and so forth – and those are all very important, but studies like this one show that psychological characteristics are equally important.”

The chronic stress was measured using ratings for five different domains of the participants’ lives:

Personal health problems

Health problems of people close to them

Job or ability to work

Relationships

Finances.

Decade-long study covered six American cities

The data for this analysis came from a study across six US sites known as the Multi-Ethnic Study of Atherosclerosis.

The 6,749 participants were from a mix of ethnic backgrounds across Baltimore, MD, Chicago, IL, Forsyth County, NC, Los Angeles, CA, New York City, NY, and Saint Paul, MN.

The almost equal numbers of men and women showed no evidence of cardiovascular disease at the start of the research in the early 2000s.

During the first 2 years of the recruitment, the baseline ratings of depression and chronic stress were assessed, and the subjects were monitored for an additional 8.5 to 11 years.

During the study, 147 strokes and 48 TIAs occurred, and the researchers did a statistical analysis at the end to compare the rates of disease between different levels of psychological health.

Possible biological mechanisms

The authors say they have excluded the possibility that the stroke results could be explained by poor psychological health tending to have a bad effect on physical lifestyle (people experiencing “stress and negative emotions typically have more adverse behavioral risk profiles, and experience difficulty in maintaining healthy lifestyles and adhering to treatment recommendations”).

The lifestyle factors taken into account were:

Smoking

Physical activity

Alcohol consumption

Body mass index

Blood pressure.

Independent of these factors, if depression and stress can be assumed to have a direct causal effect on stroke, then, the authors offer only theoretical ideas about what the biological link might be.

“Stress and negative emotions activate the hypothalamic-pituitary-adrenal axis,” they write, and this activation of the brain’s stress center influences blood clotting, among a number of other effects listed in the paper.

But these factors were not tested in the study. Another pathway that was tested, that of inflammatory effects, was tested to some extent, but “little evidence” was shown for it.

Communicating with your younger ones about your mental health

The Dilemma of CommunicationMental health patients, in general, do not confide with their children that they were in a psychiatric unit during the past few days or weeks. Instead, they prefer to give some other excuses for being away from the family home. This may be due to their own worries around children becoming over anxious about parents, or their own inability to accept that they are mentally ill, or their own anxieties around the social stigma attached to mental illness among the communities or may be their own fear of being excluded from the crowd.

Understandably the mental health patients do not want to ‘shock’ their children with the news that they have a diagnosed psychiatric disorder for which they are on treatment.

If you are suffering from mental health difficulties you need to reflect on this very seriously. Is it good to tell your kids about your mental health difficulties? Or would you prefer to keep it with yourself? Or is it still a dilemma?

Playing Hide and Seek

It is easy to play hide and seek. But it is not easy to keep a secret from others eternally. If you don’t tell your children that you are having difficulties around your mental health, someone else will tell them the fact, and very often the reported version would be an exaggerated one than the fact. When someone else tells them that you are mentally ill and they did see you in the psychiatric unit or they saw you visiting the day clinic, it is possible that your children will start thinking why you didn’t tell them. This will only increase their anxiety around how serious the issue is.

Playing hide and seek will always leave room for further doubts. When your children do not have direct information, they will start guessing, which might lead to increased levels of anxiety. Telling the truth might raise some doubts in their minds, but may not be as bad as getting a shocking story from a third party. Moreover, when they see you telling your story, they are getting first hand information and they clearly see you talking to them in real terms, which is more reassuring that you are aware of your difficulties and you are taking steps to deal with it.

The Fair Play

Children, when they are in trouble, look towards parents for support. They seek energy from parents. However, when they get the message that their parent is suffering from mental health disorder they would prefer not to approach you for support or energy, for they understand that their parent is struggling without energy. In other words, they know that the energy reservoir is empty, so there is no point approaching you!

However, when parents disclose their own mental health difficulties with the children they are giving them the positive message that mental health disorder is just like any other medical condition that could be treated with medical and therapeutic support. So, you are making them confident that you are an adult and you know how to manage your difficulties with available support. In this way you are giving the positive message that you are seeking support when you have some difficulties, and in the same way your children could very well approach you for support when they have difficulties. So, it is always good to be straight forward!

Addendum: Some young children develop self blaming for the mental health difficulties of their parent. They might believe that their behavior caused this mental health difficulty to their parent. This self condemnation could be psychologically damaging to them. So, it is important for the children to know that their parents’ mental health disorder is due to their own troubled thinking and it is not caused by anyone else. They also need to be reassured that medication and supportive counseling will fix this and parents are seeking help in this regard.